When trust in healthcare is low, misinformation often takes the place of sound medical advice, a situation which can be fatal. According to the Harvard Business Review, trust in the US healthcare system is declining. A Gallup publication reports that only 48 percent of Americans rate the quality of US healthcare as "excellent" or "good." However, healthcare facilities recognize this issue and have programs to continuously improve their quality of care, patient safety and satisfaction, and the all-important trust of the patients and the public.
What Is Quality of Care?
Quality of care refers to safe, effective, patient-centered, timely, and equitable care, as defined by the Agency for Healthcare Research and Quality and the World Health Organization (WHO). Additionally, high-quality care is associated with the best patient outcomes, patient satisfaction, effective communication, teamwork, and favorable working conditions.
Quality of care can be split into three levels that indicate the complexity of medical cases, the types of conditions a physician treats, and the specialties. High-quality care has challenges and implications at each level.
Quality of Care Examples at Three Levels of Healthcare
Take this real-life example of a patient to understand what her care looked like at each level of healthcare:
At age 12, Katie Karp was diagnosed with bone cancer, and a team of capable and caring healthcare professionals took her and her family step-by-step through chemotherapy, surgeries, and medications. After about a year of treatment, she was declared cancer-free and found herself wondering what to do with her life and her newfound future.
Her entire team, including doctors, nurses, family members, and friends, encouraged her to dream big and set exciting goals, including high school and college, running her own non-profit, and playing varsity lacrosse. She also enjoyed the small things in life, such as simply running or going to her older brother's baseball games.
Although Katie's care was mainly at the secondary level, her medical team provided safe, effective, patient-centered, timely, high-quality care at all levels, saving her life and inspiring her future.
Levels of care indicate the complexity of medical cases, the types of conditions a physician treats, and the specialties. High-quality care has challenges and implications at each level.
Primary Level Care
Primary level care is usually the first contact of patients with the healthcare system, and traditionally, at this level, a family doctor or a general practitioner manages cases such as the following:
- Common illnesses
- Minor injuries
- Screenings for common health issues
- Routine tests
- Regular physical exams and check-ups
However, effective primary care is now often delivered by multidisciplinary teams, providing a range of skills and competencies for high-quality care.
Primary health services are often where the patient develops the foundation for a trusting, therapeutic relationship with doctors, nurses, and the healthcare system. Our article on building trust with patients delves further into the nurse-patient connection.
The primary level also addresses health at a population level, for example, immunization programs, response to epidemics, or addressing health inequities and their causes.
Without high-quality primary care, minimal health issues can spiral into chronic disease; furthermore, if chronic disease management is not well coordinated, emergency room visits multiply, preventive care loses ground, and healthcare spending soars.
Secondary Level Care
The secondary level requires specialists, such as oncologists, cardiologists, gastroenterologists, urologists, and endocrinologists. This level of healthcare is often in a hospital or specialized clinic with the professional and technological capacity to help patients with more severe or complex health conditions. Katie’s cancer was probably first detected at a primary care visit. However, most of her subsequent care occurred in a secondary care setting.
One issue impacting the quality of both secondary and tertiary healthcare is the high cost, which can lead to postponing the needed care. According to KFF, approximately half (47 percent) of US adults state that it is difficult to afford healthcare costs. One in four adults say that in the past 12 months, they have skipped or postponed getting the healthcare they needed because of the cost.
On the other hand, reducing costs may compromise the quality of care.
Fragmented care is another challenge patients, clinicians, and facilities face. Patients may see several specialists in different healthcare systems, which often leads to duplicate tests and inconsistent or differing medication that may confuse or discourage the patient.
Suitable communication with the patient and among clinicians improves patient outcomes and satisfaction. Many healthcare organizations invest in training and technology for optimum communication.
Tertiary Level Care
Tertiary care refers to specialized care and expertise typically requiring hospitalization and advanced equipment to resolve severe or rare medical situations. In some cases, tertiary care requires transferring a patient to larger metropolitan medical centers. For instance, Katie Karp, was likely transferred to a tertiary-level hospital for surgeries. Examples of tertiary care can include the following:
- Aortic dissections
- Advanced neonatology services
- Hemodialysis
- Coronary artery bypass
- Organ transplants
- Neurosurgery
- Severe burn treatments
High-quality tertiary care depends on clinical capabilities and non-clinical functions such as effective patient and community engagement, leadership, communication, and innovation.
What Are the Major Benefits of Prioritizing Quality of Care?
There are multiple and multifaceted benefits of prioritizing quality of care:
- Improved individual and population health outcomes
- Reduced readmissions
- Consistent compliance with national standards
- High patient satisfaction
- Sustained CMS funding
- Increased trust on behalf of patients, clinicians, and the public
All these benefits interrelate and form a culture of excellence.
Common Challenges to Providing Quality Care to Patients
There is no shortage of challenges in healthcare. However, here are a few of the most significant obstacles to providing quality care to patients:
Balancing costs with affordability
Increasing demand for healthcare services and high costs strain the system and generate stress for clinicians, challenging healthcare quality while feeding into a cycle of nurse turnover, shortage, disturbing nurse-to-patient ratios, high workload, nurse burnout, and more turnover. Healthcare organizations face high costs throughout the industry that fuel patients' affordability concerns.
Aging populations and the nursing workforce demographics
There is no doubt that patients deserve the highest quality of care. However, as the nursing workforce ages, the healthcare industry faces an even more severe nursing shortage with repercussions on the quality of care patients can receive.
Healthcare staff struggling with disengagement
Sometimes, the inherent stress in nursing becomes overwhelming due to heavier workloads. Nurse disengagement may appear when nurses suffer compassion fatigue and inadvertently show a lack of genuine caring, clearly causing lower quality of care and diminished patient satisfaction.
How Do Nurses Contribute to a Patient's Quality of Care?
Nurses determine the patient experience and quality of care with skills, attitudes, and knowledge.
Patients often spend a lot of time with nurses whose capacity, care, and understanding build trust. The following are nurses' responsibilities directly impacting healthcare quality, to mention a few.
- Communication: Listening compassionately and explaining issues the patient needs to understand
- Patient engagement: Teaching patients about their conditions, medication, and options and involving them in decisions regarding their care plan
- Direct patient-centered care: Providing comfort and alleviation of pain, preventing medication errors, advocating for patients’ needs, and educating patients to involve them in the therapy and care plan and prevent readmissions
- Organization: Ensuring coordination among the clinicians on the healthcare team
- Monitoring: Keeping carefully updated records and watching for changes in the patient's physical or emotional state, thus allowing early intervention
Nurses' dedication and expertise in patient care can save and empower lives while enhancing institutional capacity.
5 Techniques to Improve Quality of Care at Your Facility
Here are five practical ways to enhance the quality of healthcare patients can receive at your facility.
1. Provide Ongoing Training and Education
The following are essential areas to consider for staff training and education:
- Ensure staff are current with evidence-based practices—judicious integration of the best external evidence, clinical expertise, and the patient's values and expectations.
- Promote a safety culture with training on clear, open communication regarding safety issues without fear of punitive measures.
- Strengthen coordination with training on patient-centered care.
- Foster the practice of patient advocacy.
- Train personnel in the use of new technologies.
2. Involve and Educate Patients throughout Their Care
Engage patients and their families as active stakeholders in their care and recovery to keep the process patient-centered and improve compliance with the care plan.
3. Work with Clinicians to Reduce Waste
Involve the clinicians and personnel in understanding where inefficiencies exist and planning strategies for reducing the following types of waste and improving health care quality.
- Medical waste: Potentially contaminated materials ranging from used needles and syringes to soiled dressings, body parts, test samples, blood, chemical substances, pharmaceuticals, medical devices, and radioactive materials—all dangerous due to toxic or infectious exposure, or injury from sharps
- Waste of time: Waiting in general or hunting for materials, equipment, or supplies
- Waste of equipment: Underutilized equipment due to lack of training or damaged equipment due to improper handling
4. Maintain Safe Working Conditions for Staff
Healthcare workers can't provide high-quality care if they lack training, are overworked, or burned out. Nurse well-being directly impacts the quality of patient care, and ensuring enough nurses on duty to cover a healthy nurse-to-patient ratio is crucial to reducing stress and increasing engagement. To help manage this challenge, Nursa offers a healthcare platform that connects facilities with nurses to quickly fill gaps in the schedule.
5. Work with Staff to Improve the Quality of Care in Nursing
Nurses who work closely with patients will have ideas for improving healthcare quality. Your facility can benefit from consulting with nursing staff to understand the meaning of quality of care and what resources, support, or changes are needed to improve patient outcomes and well-being.
Improving Quality of Care Is an Organization-Wide Effort
Quality of care and trust are essential to health and well-being and depend on the efforts and programs to identify and face the challenges, provide well-designed training, and increase the involvement and engagement of nurses and doctors in plans and measures to improve patient care. Learn more about the patient-centered experience, why it matters, and how it improves the quality of care.
